MacLean C D, Berger C, Cangiano M L, Ziegelman D, Lidofsky S D
Division of General Internal Medicine, Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA.
Department of Family Medicine, Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA.
J Viral Hepat. 2018 Aug;25(8):939-944. doi: 10.1111/jvh.12885. Epub 2018 Mar 30.
Screening for hepatitis C virus (HCV) was recommended in 2012 by the Centers for Disease Control (CDC) for the population born between 1946 and 1965. Reminder systems are effective at promoting HCV screening, but the yield of positive tests among various population subgroups and the linkage to specialty HCV treatment is not well understood. We sought to determine: (i) the effect of the CDC recommendation alone, and the effect of an electronic medical record (EMR) reminder on the proportion of the population screened; (ii) the yield of positive HCV tests as screening strategies have evolved, and according to a patient's history of serum aminotransferase testing; (iii) the proportion of positive cases followed up for HCV treatment. This retrospective cohort study included 60 000 primary care patients at a northeast US academic medical centre serving an urban and rural population in which an EMR reminder was instituted in 2014. Results demonstrated an increase in proportion tested for HCV from 12% prior to the CDC recommendation to 37% after the reminder system. The yield of positive HCV antibody (HCV Ab) tests decreased from 7% in the "case-finding" era to 1.6% after the EMR reminder prompted screening of a lower risk population (P < .001). Patients with a history of abnormal aminotransferase tests had a fivefold higher rate of positive HCV Ab testing (6.7% vs 1.5%, P < .001). Ninety per cent of patients with confirmed HCV infection were seen in specialty care.
2012年，美国疾病控制中心（CDC）建议对1946年至1965年出生的人群进行丙型肝炎病毒（HCV）筛查。提醒系统在促进HCV筛查方面是有效的，但不同人群亚组中阳性检测的检出率以及与HCV专科治疗的联系尚不清楚。我们试图确定：（i）仅CDC建议的效果，以及电子病历（EMR）提醒对筛查人群比例的影响；（ii）随着筛查策略的演变以及根据患者血清转氨酶检测史，HCV检测阳性的检出率；（iii）接受HCV治疗随访的阳性病例比例。这项回顾性队列研究纳入了美国东北部一家学术医疗中心的60000名初级保健患者，该中心服务于城乡人口，2014年实施了EMR提醒。结果显示，HCV检测比例从CDC建议前的12%增加到提醒系统实施后的37%。HCV抗体（HCV Ab）检测阳性率从“病例发现”时代的7%下降到EMR提醒促使对低风险人群进行筛查后的1.6%（P <.001）。有转氨酶检测异常史的患者HCV Ab检测阳性率高出五倍（6.7%对1.5%，P <.001）。90%确诊为HCV感染的患者接受了专科护理。
